Bülent ÖZDEMİR, Murat BİÇER, Hüseyin MELEK, Ahmet Sami BAYRAM, İrem İris KAN

Küçük anterior torakotomi ile perikardiyoplevral pencere açılması

Amaç: Bu çalışmada, küçük anterior torakotomi ile açılan perikardiyoplevral pencerenin perikardial efüzyon tanı ve tedavisindeki etkinliğinin araştırılması amaçlandı. Çalışma planı: Ocak 2006 - Ocak 2011 tarihleri arasında, plevral efüzyon nedeniyle perikardiyoplevral pencere açılan toplam 52 hastanın verileri (27 erkek, 25 kadın; ort. yaş 61.8 yıl; dağılım 45-78 yıl) retrospektif olarak incelendi. Perikardiyal efüzyon tanısı ekokardiyografi veya bilgisayarlı tomografi ile konuldu. Perikardiyoplevral pencere ana patolojiye bağlı olarak sağ veya sol altıncı veya yedinci kaburgalar arası aralıktan küçük anterior torakotomi ile açıldı. İnsizyonlar yaklaşık 5 ila 7 cm uzunluğundaydı. Perikardın anterior yüzünden frenik sinire doğru 2x2 cm boyutunda bir pencere açıldı. Bulgular: Perikardiyoplevral pencere açılma endikasyonları 20 hastada malign efüzyon, 20 hastada idiyopatik nedenler, dokuz hastada enfektif nedenler ve üç hastada geçirilmiş kardiyak ameliyat idi. Ortalama ameliyat süresi 42.2 dakika (dağılım 32-65) idi. Ameliyat sırası ve sonrası morbidite ve mortalite ile karşılaşılmadı. Ortalama hastanede kalış süresi 5.6 (dağılım 2-15) gün idi. Sonuç: Küçük anterior torakotomi ile perikardiyoplevral pencere açılması, perikardiyal mayinin drenajı ve perikardiyal biyopsi için etkili bir tekniktir.

Pericardiopleural window creation with a small anterior thoracotomy

Background: This study aims to investigate the efficacy of pericardiopleural window created by small anterior thoracotomy in the treatment and diagnosis of the pericardial effusion.Methods: Between January 2006 and January 2011, data of a total of 52 patients (27 males, 25 females; mean age 61.8 years; range 45 to 78 years) underwent pericardiopleural window due to pleural effusion were retrospectively analyzed. Pericardial effusion was diagnosed with echocardiography or computed tomography. A pericardiopleural window was created via a small anterior thoracotomy in the right or left sixth or seventh intercostal space according to the main pathology. Incisions were about 5 to 7 cm long. A 2x2 cm window in size was created from anterior surface of the pericardium to the phrenic nerve.Results: Indications for pericardiopleural window creation were malignant effusions in 20 patients, idiopathic causes in 20 patients, infective causes in nine patients and previous cardiac surgery in three patients. The mean duration of surgery was 42.2 minutes (range, 32 to 65). No intraoperative and postoperative mortality and morbidity was seen. The mean length of hospital stay was 5.6 (range 2 to 15) days.Conclusion: Pericardiopleural window creation with small anterior thoracotomy is an effective technique for drainage of the pericardial fluid and pericardial biopsy.

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